To help diagnose and distinguish between autoimmune disorders as well as to monitor autoimmune disease progression
When your antinuclear antibody (ANA) test is positive and you have symptoms that suggest an autoimmune disorder; when monitoring the activity of an autoimmune disorder
A blood sample drawn from a vein in your arm
An extractable nuclear antigen (ENA) panel detects the presence of autoantibodies in the blood that react with proteins in the cell nucleus. These proteins are known as "extractable" because they can be removed from cell nuclei using saline and represent six main proteins (Ro, La, Sm, RNP, Scl-70 and Jo1).
Autoantibodies are produced when a person's immune system mistakenly targets and attacks the body's own tissues. This attack can cause inflammation, tissue damage, and other signs and symptoms that are associated with an autoimmune disorder.
Certain autoimmune disorders are characteristically associated with the presence of one or more anti-ENA antibodies. Autoantibody association can aid in the diagnosis of an autoimmune disorder and help distinguish between other autoimmune disorders.
The ENA panel typically consists of a group of 4 or 6 autoantibody tests. The number of tests performed will depend on the laboratory and the needs of the healthcare practitioners and patients it serves. Individual ENA panel tests can also be ordered separately.
A 4-test ENA panel will include:
|Autoantibody Test||Formally Known As|
|Anti-SS-A (Ro)||Anti-Sjögren Syndrome A|
|Anti-SS-B (La)||Anti-Sjögren Syndrome B|
A 6-test ENA panel will include the four tests listed above as well as:
|Autoantibody Test||Formally Known As|
|Anti-Scl-70||Scleroderma Antibodies; anti-topoisomerase|
|Anti-Jo-1||Anti-Histidyl Transfer RNA Synthase Antibodies|
The ENA panel may be used as follow-up testing to a positive ANA test to help diagnose an autoimmune disorder. Testing may be used to help distinguish between autoimmune disorders as well as to monitor autoimmune disease progression.
The 4-test ENA panel is used to help diagnose mixed connective tissue disease (MCTD), lupus (SLE), and Sjögren syndrome. The 6-test ENA panel can also help identify scleroderma and polymyositis/dermatomyositis. For more on these diseases, see the links under Related Content below.
An ENA panel may also be used to monitor the activity of a particular autoimmune disorder in conjunction with clinical examination.
An ENA panel is ordered when a person has signs and symptoms that could be due to an autoimmune disorder and has a positive ANA test. Signs and symptoms of autoimmune disorders are highly variable and can involve several different areas of the body. They may include:
An ENA panel will not be ordered when a person has a negative ANA test. The ANA test evaluates the presence or absence of autoantibodies, while the ENA panel aims to determine to what proteins in the cell nucleus the autoantibodies recognize. If an ANA test is negative, then the person is extremely unlikely to test positive for a specific antinuclear antibody (which is what the ENA panel tests).
The ENA panel, or one or more of its component tests, may be repeated when initial test results are negative but clinical signs and symptoms persist. Testing may also be ordered when a person has been diagnosed with an autoimmune disorder and at some point develops symptoms that may be due to an additional autoimmune disorder. A healthcare practitioner also may order testing to monitor the activity and/or progression of a known autoimmune disorder.
Diagnoses of autoimmune diseases are typically based on the characteristic signs and symptoms and on results of autoantibody tests. ENA panel results aid in detecting and distinguishing between different autoimmune disorders. Studies have shown that each of these autoantibodies is frequently detected in people who have a specific autoimmune disorder and is less frequently detected or not detected in those without the disease.
The pattern of positive and negative results obtained with an ENA panel is evaluated in conjunction with the person's clinical findings (signs and symptoms). If someone has clinical findings that suggest a specific autoimmune disorder and the corresponding ENA autoantibody is positive, then it is likely that the person has that condition.
If an individual has symptoms but the autoantibody is not present, it may mean that symptoms are due to another condition.
Interpretation of results for the tests included in an ENA panel are provided in the table below. A positive test result means that the person has more of that autoantibody in their blood than the designated reference value.
|Autoantibody Test||Results That Support an Autoimmune Disorder Diagnosis|
|Anti-RNP||Positive result seen in 95-100% of mixed connective tissue disease (MCTD) cases; may also be positive with lupus and scleroderma|
|Anti-Sm||Positive result seen in 30% of those with lupus; very specific antibody marker for this disease|
|Anti-SS-A (Ro)||Positive result seen in 75% of those with Sjögren syndrome; may also be positive with lupus and scleroderma|
|Anti-SS-B (La)||Positive result seen in 60% of those with Sjögren syndrome; may also be positive with lupus and scleroderma; rarely present without anti-SS-A|
|Anti-Scl-70||Positive result seen in 60% of those with scleroderma; highly specific antibody marker for this disease|
|Anti-Jo-1||Positive result seen in 30% of those with polymyositis; may be positive with pulmonary fibrosis|
ENA are referred to as "extractable" or "saline-extracted" because of the laboratory method originally used to discover and work with these antigens. More than 100 antigens have been identified in this way, but only a few are clinically relevant and routinely tested.
Levels may fluctuate, but once a person has developed an autoantibody, he or she will continue to have it.
No. The ENA tests require specialized equipment and skilled laboratory personnel. Your sample will need to be sent to a reference laboratory that performs these tests.
This depends on the laboratory performing the testing. Since this is specialized testing and your sample may be sent to a reference laboratory, it may take several days for results to be available.
The panel performed will usually be the one offered by the laboratory that tests your sample. If a 4-test panel is ordered and your doctor is interested in additional tests, he or she can order the others separately as needed to ensure that nothing is missed.
Sources Used in Current Review
2017 review completed by Boris Calderon, MD, DABCC, FAACC, Associate Medical Advisor, Eli Lilly and Company.
Aggarwal A. Role of autoantibody testing. Best Pract Res Clin Rheumatol. 2014 Dec;28(6):907-20. doi: 10.1016/j.berh.2015.04.010. Epub 2015 May 23. Available online at http://www.sciencedirect.com/science/article/pii/S1521694215000170?via%3Dihub. Accessed on 6/15/2017.
Ortega-Hernandez O, Shoenfeld Y. Mixed connective tissue disease: An overview of clinical manifestations, diagnosis and treatment. Best Pract Res Clin Rheumatol. 2012 Feb;26(1):61-72. doi: 10.1016/j.berh.2012.01.009. Available online at http://www.sciencedirect.com/science/article/pii/S1521694212000101. Accessed on 6/15/2017.
Arthur Kavanaugh, Russell Tomar, John Reveille, Daniel H. Solomon, and Henry A. Homburger. (2000) Guidelines for Clinical Use of the Antinuclear Antibody Test and Tests for Specific Autoantibodies to Nuclear Antigens. Archives of Pathology & Laboratory Medicine: January 2000, Vol. 124, No. 1, pp. 71-81. Arch Pathol Lab Med. 2000 Jan;124(1):71-81. Available online at http://www.archivesofpathology.org/doi/full/10.1043/0003-9985%282000%29124%3C0071%3AGFCUOT%3E2.0.CO%3B2. Accessed on 6/15/2017.
Sources Used in Previous Reviews
(© 1995-2010). Unit Code 89035: Antibody to Extractable Nuclear Antigen Evaluation, Serum. Mayo Clinic, Mayo Medical Laboratories [On-line information]. Available online at http://www.mayomedicallaboratories.com/test-catalog/Overview/89035. Accessed March 2010.
(© 2006-2010). Extractable Nuclear Antigen Antibodies (RNP, Smith, SSA, & SSB): 0050652. ARUP's Laboratory Test Directory [On-line information]. Available online at http://www.aruplab.com/guides/ug/tests/0050652.jsp. Accessed March 2010.
Hill, H. and Tebo. (Updated 2009 November). Mixed Connective Tissue Disease – MCTD. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/MCTD.html?client_ID=LTD#. Accessed March 2010.
Hill, H. and Tebo. (Updated 2009 August). Connective Tissue Diseases. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/ConnectiveTissueDz.html?client_ID=LTD. Accessed March 2010.
(© 1995-2010). Unit Code 83631: Connective Tissue Diseases Cascade, Serum. Mayo Clinic, Mayo Medical Laboratories [On-line information]. Available online at http://www.mayomedicallaboratories.com/test-catalog/print.php?unit_code=83631. Accessed March 2010.
Klein-Gitelman, M. (Updated 2009 September 29). Mixed Connective Tissue Disease. eMedicine [On-line information]. Available online at http://emedicine.medscape.com/article/1006966-overview. Accessed March 2010.
Hildebrand Jr., G. and Battafarano, D. (Updated 2009 July 24). Undifferentiated Connective Tissue Disease. eMedicine [On-line information]. Available online at http://emedicine.medscape.com/article/334482-overview. Accessed March 2010.
Hajj-ali, R. (Revised 2008 February) Mixed Connective Tissue Disease (MCTD). Merck Manual for Healthcare Professionals [On-line information]. Available online at http://www.merck.com/mmpe/sec04/ch032/ch032c.html. Accessed March 2010.
Pagana, K. D. & Pagana, T. J. (© 2007). Mosby's Diagnostic and Laboratory Test Reference 8th Edition: Mosby, Inc., Saint Louis, MO. Pp 81-82.
Wu, A. (© 2006). Tietz Clinical Guide to Laboratory Tests, 4th Edition: Saunders Elsevier, St. Louis, MO. Pp 128-129, 136-139.
Bartels, Christie M., et al. (Updated Jan. 28, 2013.) Systemic Lupus Erythematosus (SLE) Workup. Medscape online. Available online at http://emedicine.medscape.com/article/332244-workup. Accessed January 2014.
Orton, Susan M., et al. (March 2004). Practical Evaluation of Methods for Detection and Specificity of Autoantibodies to Extractable Nuclear Antigens. American Society for Microbiology, Clinical and Vaccine Immunology online. Available online at http://cvi.asm.org/content/11/2/297.full. Accessed January 2014.
Antibodies to Extractable Nuclear Antigens. Children's Hospitals and Clinics of Minnesota. Available online at http://www.childrensmn.org/Manuals/Lab/FlowCyt/018959.pdf. Accessed January 2014.
Kavanaugh, Arthur, et al. (January 2000.) Guidelines for Clinical Use of the Antinuclear Antibody Test and Tests for Specific Autoantibodies to Nuclear Antigens. Archives of Pathology and Laboratory Medicine. Available online through http://www.archivesofpathology.org. Accessed January 2014.